Abstract
Persistent left superior vena cava (PLSVC) is the most common venous anomaly of the thorax that usually coexists with the right superior vena cava. However, in a minority of cases, there is only a PLSVC without a right superior vena cava which is called an isolated PLSVC. There are some reported anomalies that can co-occur with PLSVC; yet, none have reported an association with autosomal dominant polycystic kidney disease (ADPKD). In this case report, we describe a 41-year-old man with end-stage renal disease from ADPKD who underwent central venous catheterization (permacath) to initiate hemodialysis. Upon catheterization, a complete right internal jugular vein septum (bicuspid valve) was found, along with an isolated PLSVC that drained directly in the coronary sinus. We demonstrate the multiple challenges encountered during the catheterization procedure and we illustrate the anomaly with detailed images and supplementary videos. Furthermore, we discuss the coexistence of PLSVC with renal anomalies in the context of previous literature. To conclude, interventional radiologists should keep the possibility of PLSVC in mind, especially when difficulties are encountered during catheterization where proper characterization of the PLSVC type and associated anomalies is crucial for tailoring the best management approach. Moreover, an association between venous anomalies including left superior vena cava and renal anomalies may co-exist, and further studies are needed to explore this possible association.
Highlights
Persistent left superior vena cava (PLSVC) is the most common venous anomaly of the thorax that usually coexists with the right superior vena cava
To further characterize the vascular anatomy of the patient and associated anomalies, a detailed cardiac MRI and 3D reconstruction technique of CT scans were performed. This showed the right brachiocephalic vein directly connected to the isolated PLSVC draining into the coronary sinus, which drained into the right atrium (Figures 6-7)
PLSVC is usually diagnosed during fetal life or as an incidental finding that is discovered after central venous catheterization is done for various reasons [1]
Summary
Persistent left superior vena cava (PLSVC) is the most common venous anomaly of the thorax that usually coexists with the right superior vena cava. VIDEO 2: Fluoroscopy video during catheterization upon contrast injection at the level of the right brachiocephalic vein showing the drainage to the isolated PLSVC into the dilated coronary sinus (without any leakage into the left atrium) into the right atrium. To further characterize the vascular anatomy of the patient and associated anomalies, a detailed cardiac MRI and 3D reconstruction technique of CT scans were performed This showed the right brachiocephalic vein directly connected to the isolated PLSVC draining into the coronary sinus, which drained into the right atrium (Figures 6-7). This emphasizes the importance of proper documentation of radiology reports on the patient electronic medical records, in addition to performing a thorough review of the patients' radiology reports before such complex interventions
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